Maharashtra

Model Medicine Prescription

Format
“Committed to Improve
Health Status of Maharashtra”

Hon. Shri Prithviraj Chavan

Chief Minister, Maharashtra

Issued by :
The Commissioner,
Food & Drug Administration, Maharashtra State,
Survey No. 341, Bandra Kurla Complex, Bandra (East), Mumbai - 400 051
web site:- fda.maharashtra.gov.in Email:- comm.fda-mah@nic.in
February-2014
 Messages

“Healthy Citizens..., First Priority”

Hon. Shri. Ajit Pawar

Deputy Chief Minister, Maharashtra

“Safe Medication For Longevity”

Hon. Shri. Manoharrao Naik

Minister- Food & Drug Administration,
Maharashtra

“Towards Healthier Society”

Hon. Shri. Suresh Shetty

Minister - Public Health & Family Welfare
and Protocol, Maharashtra

“Yes ! We Care For People”

Hon. Shri. Satej Patil

Minister of State - FDA, Home &
Rural Development, Maharashtra

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 Introduction

The average longevity of citizens in Maharashtra has gone up from 53.8

years to 73.4 years in last 4 decades due to progress in scientific health care,
attributed, inter-alia to judicious use of medicines. However, if administered
improperly, the adverse impact of medicines on human body and mind
becomes catastrophic on individual patient, society and future generations
that includes organ failure, health complications, death, drug resistance etc.
and this has been recognized internationally.
The Food & Drug Administration Maharashtra, during last 2 years, has
initiated far reaching comprehensive measures to safeguard citizens ‘ health
through stringent implementation of patient centric provisions in Drugs &
Cosmetics Act 1940 like presence of pharmacist in retail drug stores, sell of
prescription drug on prescription and sell of drugs with bill only. This has
brought out very positive results and would go a long way in raising health
status of people of Maharashtra.
As a part of above initiative, it was felt necessary that there is a need
for uniform prescription format commensurate with legal provisions.
To formulate such model prescription format a committee under the
chairmanship of Shri. Mahesh Zagade, IAS, Commissioner, FDA was
constituted on 24th July 2013, comprising representatives from Food &
Drugs Administration, Maharashtra Medical Council, Maharashtra Council
of Indian Medicine, Maharashtra Veterinary Council, Maharashtra Dental
Council, Indian Pharmaceutical Association, Indian Medical Association,
National Integrated Medical Association (Maharashtra Branch) and
Maharashtra State Pharmacy Council. After long deliberations a consensus
based “Model Medicine Prescription Format” has been designed and is now
being circulated to all the stake holders as a legal mandatory prescription
format.

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 MAHARASHTRA MODEL PRESCRIPTION FORMAT

Doctor’s (Prescriber’s) Full Name D1

Qualification (eg.M.B.B.S., M.D.) D2
Reg. No.: (specify alphabets specifying pathy) /Reg. NoD3
Full Address, D4 Contacts: (telephone no, email etc ) D5

Prescription Serial Number D9 Date: dd/mm/yy D6

44

Patient’s full Name P1

Patient’s Address and Phone number:P2

SexP3.......AgeP4 .......WeightP5………

RxD10
1) Name of Medicine M1, As far as possible, generic name in capital letters.

StrengthM2, dosage formM3, dosage instructionM4, duration & total quantityM5

2)

3)

“ Or any other cheaper generic medicine as per choice of patient.”

Doctor’s signature & dateD7

Doctor’s stamp D8
5

Dispensed By : If entire prescription is not dispensed, specify name

Name and Address of Medical Store, or number of medicine and quantity dispensed.
Date of dispensing :- Name and Address of Medical Store,
Date of dispensing :-

Minimum size of the prescription blank should be: 14 X 21cm (A5 size)
 A guide to the prescription format
The prescription should have following particulars pertaining to
Doctor, Patient and Medicines as indicated below -
D – About Doctor / Prescriber P – About Patient M – About Medicine
Act means - Drugs & Cosmetics Act 1940. Rules means - Drugs & Cosmetics Rules 1945

Sr.No. Particulars Requirements & necessities

It is statutory requirement to mention name of the prescriber on cash

Doctor’s full or credit memo of the drugs under Rule 65(3) and it is also necessary to
D1 name authenticate prescription. Therefore, the prescription shall bear Doctor’s
full name as mentioned in her / his registration certificate.
To know competency and genuineness of prescriber, the prescription
Doctor’s
D2 qualifications
shall bear Doctor’s primary qualification such as MBBS / BAMS followed by
subsequent qualifications. For example MBBS MD or BAMS MD.
Prescription shall bear the registration number of doctor’s registration with
their respective council. The registration number should be prefixed with
Registration
D3 no.
letters indicating the council in which doctor has registered her /his name.
For example: Allo. (Allopathic), Intgrtd. (Integrated Medicine), Homeo.
(Homeopathic), Dental (Dentist), Vet. (Veterinary), etc.
It is statutory requirement to mention the address of the prescriber on the
cash or credit memo of the drugs under Rule 65 (3) and the patient and
Address of
D4 doctor
pharmacist should know where the prescriber is practicing and, therefore,
prescription shall bear complete address of clinic / hospital where the
prescriber is practicing.
The prescription shall have telephone number (Landline / Mobile) and
D5 Contacts :- e-mail of the prescriber. These details will help patient as well as pharmacist
to contact doctor, if required.

As per the Rule 65 (10) prescription shall be dated. The date of prescription
Date of is also essential to know the validity of prescription and to avoid misuse of
D6 prescription such prescription.

Doctor’s As per Rule 65 (10) prescription shall be signed by the person issuing it
D7 signature & with her / his usual signature and, therefore, the prescription shall have full
date signature of prescriber with date.

To authenticate prescription and also to avoid misuse of blank prescription

Doctor’s and to protect patient from quacks and un-qualified doctors, the
D8 Stamp prescription should have doctor’s rubber stamp containing his/ her full
name, qualifications and registration number below his signature.
Prescription
For traceability and purposes of record the prescriptions must be serially
D9 serial
numbered.
number
Rx - super-
D10 scription
As a matter of practice the prescription may bear Rx-superscription.

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 As per Rule 65 (10), prescription shall specify the name and address of the
Patient’s full person for whose treatment it is given or name & address of the owner of
P1 name the animal if the drug is meant for veterinary use. Therefore, prescription
shall bear patient’s / animal owner’s full name.

As per Rule 65 (10), prescription shall specify the name and address of the
person for whose treatment it is given. It is also essential for follow up of
Patient’s full
P2 address
patient, or to get in touch with patient in case of dispensing or prescribing
errors and also essential for recall of medicines, if required. Therefore, the
prescription shall bear patient’s full address.

As certain drugs are gender specific, sex of the patient should be mentioned
P3 Patient’s sex
on prescription.

The drug dosages may differ with age of patient and, therefore, prescription
P4 Patient’s age
must bear patient’s age.

Patient’s The drug dosages may vary with weight of the patient, therefore,
P5 weight prescription may bear patient’s weight.

a) The Indian Medical Council (Professional Conduct, Etiquette and Ethics)

Regulation, 2002 under Indian Medical Council Act 1956 under Code
of Medical Ethics at 1.5 prescribes as “Every physician should as far as
possible prescribe drugs with Generic names and he / she shall ensure
that there is a rational prescription and rational use of drugs”.
Name of the
M1 medicine Therefore, prescription shall bear the name of medicine as Generic name.
The name of medicine should be in Capital letters in legible manner.
b) If the prescriber is not sure about generic name he shall add following
instructions on the prescription above her/his signature.
“Or any other cheaper generic medicine as per choice of patient.”

Strength of Prescription shall invariably bear strength of the medicine.

M2 drug eg. PARACETAMOL TABLETS 500 mg., AMOXYCILLIN CAPSULES 250 mg.

Prescription shall bear a proper dosage form of medicine prescribed.

M3 Dosage form
eg. Tablets, Capsules, Syrups, Creams etc.
Prescription shall bear proper dosing instructions that could be easily
understood by patient or owner of animal in case of veterinary drugs.
Dosing (Preferably in marathi or any other language easily understood by the
M4 instructions patient or owner of animal.
eg. 1 (after breakfast)------0------1 (after dinner)
1 (empty stomach)----0
Prescription shall specify duration of the treatment and total quantity of
the medicine for that duration.
Total quantity
of medicine eg. Medicine 1 ----- 1 tab x 2 times a day for 7 days
M5 and duration = 14 tablets
Medicine 2 ----- 1 tab per day for 3 months
of medication.
= 90 tablets

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 General guidelines for Doctors / Prescriber

Sr.
No.
Suggestions

1. Changes in prescription :
If any changes are warranted in prescription please issue fresh prescription.

2. Do not use prescription pad with the name of medical store.

Doctors should not use prescription pads, with pre-printed messages,
like “Available at XYZ Medical Stores”.
3. Do not print names of more than one doctor on the prescription.
One should avoid having names of two or more doctors on the same prescription pad
(even if it is a husband and wife team).

4. Do not use prescription pad of another doctor.

A doctor should not use another doctor’s prescription pad, even with her / his consent.
Conversely a doctor should not allow other doctor to use her / his prescription pad.
5. Precaution about computer generated prescription.
If the doctor types or generates her / his prescription on a computer, she /he must ensure that
he / she issue it with her / his full, recognizable dated signature in ink. She / he must sign as
close as possible to the last drug listed in the prescription.
6. Prescription of certain medicines by specialist.
Certain medicines can be supplied on the prescription by specific specialist only.
For example, Sildenafil Citrate can be prescribed only by an Urologist, Psychiatrist,
Endocrinologist, Dermatologist or Venerologist. Letrozole can be prescribed by a Cancer
specialist only.

7. Recognize the services of Pharmacist :-

As per internationally recognized practice, especially followed in the developed world, doctors
should recognize importance of services of pharmacist as they are required to supervise sale
of medicines under the law and also responsible for counseling the patients. The pharmacist is
trained to recognize therapeutic incompatibility, absorption incompatibility, etc of medicines
in addition to various facets of pharmacological effects of medicine. In view of the above, the
doctors should consider her / him as a resource person and his / her view should be considered
with due regard to her / his knowledge.

Food & Drug Administration, Maharashtra State,

Survey No. 341, Bandra Kurla Complex, Bandra (East), Mumbai -400 051
Tel.:- 022-2659 2361,62,63,64,65. Email:- comm.fda-mah@nic.in
web site:- fda.maharashtra.gov.in